Provider Demographics
NPI:1215964283
Name:RIVERSIDE OBSTETRICIANS AND GYNECOLOGISTS, INC.
Entity type:Organization
Organization Name:RIVERSIDE OBSTETRICIANS AND GYNECOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DREMA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-268-3581
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 114
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-268-3581
Mailing Address - Fax:614-268-8171
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE 114
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-268-3581
Practice Address - Fax:614-268-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0700450OtherUNITED HEALTH CARE
OH0120176Medicaid
OH000000160536OtherANTHEM
OH8467396OtherAETNA
OH0700450OtherUNITED HEALTH CARE
OHRI9926521Medicare PIN